“No Butts About It, Let’s Wipe It Away…..”

1. “No Butts About It,Let’s Wipe It Away…..” Debra Berube MS RNC CIC Director of Infection Control & Prevention St Vincent Hospital Worcester MA APIC NE October 13, 2011

2. Brief Outline • C.Diff rates, historical, current, and goals • Contact Plus precautions and its implementation • Hand Hygiene program • rates • compliance observations • non-compliance • Team effort • What’s next

3. 2008-2010 SVH: C.Diff rates Per 10,000 patient days 2011

4. SVH: C. Diff: Rate per 10,000 pt days 2008-2011 (through September)

5. This NO FOAM sign is posted in addition to Contact Precautions sign • Alcohol foam is removed from inside of the patient room • Patient and family education • Terminal clean upon transfer or discharge NO FOAM ROOM PLEASE WASH HANDS WITH SOAP AND WATER PRIOR TO LEAVING

6. Infection Preventionists: • Maintain daily list of all patients • admitted that have MDRO, C.Diff. • This list includes all other types • of isolation as well. • Along with staff, maintain • appropriate environmental controls • Daily rounding on all patients in isolation • Patient education oversight of all patients with MDRO including • C.Diff. Daily reminder to nursing staff of patient education needs. • Patient education brochures: MA DPH, CDC, Krames On-Demand • Dissemination of monthly data to all nursing areas Environmental controls

7. Amount of emphasis on hand hygiene and rates of HAI C. Diff seem to go hand in hand at our facility. Hmmm..... That would mean: if hand hygiene rates increase then HAI C. Diff would decrease. All other HAI’s will follow....

8. Hand Hygiene Program • Education upon orientation, annual competencies, as needed • Patients, visitors encouraged to wash hands • Daily update at morning huddle: • current rate, # observations done, days left in the month • Movie themed posters: • Field of Germs • Staph Wars • E.G. the Extra-Germestrial • etc. • Other posters rotated to prevent sign fatigue

11. The posters : • 20 x 26 inches • professionally printed • for staff and visitors..... patient empowerment! • washable • eye-catching!! • fun • Problems: • poster / sign fatigue • rotate them unit unit • create new ones • move locations

12. 12 different posters of children and animals, 8 ½ x 11 inches, laminated, washable.

14. Always FoamOUT Always FoamIN Clean Hands Save Lives • Small 4 x 3 ½ inch magnetized signs that are attached to every patient doorway • Problem: • They tend to “disappear” and must be replaced frequently. • IC practitioner carries them during daily rounds for replacing.

15. Hand Hygiene Program (continued) • Hand hygiene monitoring • 46 hand hygiene observers • each observer has monthly assignment to specific units • minimum of 500 observations per month (more is always OK!!!) • real-time feedback • NO person is exempt from being observed • IP cannot observe for statistics.......are considered “biased” • IP’s can issue “tickets” if violations are observed by IP’s • “Ticket” for attending physicians results in $100 fine per violation, must be paid before allowed to recredential • Weekly update sent via email to all observers and leadership team

16. Thanks for being a STAR and keeping our patients safe! ♪ You were observed performing Hand Hygiene ♪ Name: _______________________________________ Date: _______________________________________ Observer:_______________________________________ Infection Control Committee: Violation Documentation Form Date of Event: ________________ Location: _______________ Name of Person Observed ___________________________________ Deviation (check all that apply): • Was observed not disinfecting hands before / after direct patient contact ______ • Was observed not adhering to posted precautions ______ 3. Was observed eating or drinking in patient care area. ______ • Was seen inappropriately discarding infectious waste ______ • Action: Deviation brought to person’s attention YesNo Comment: ________________________________________________________ _________________________________________________________ Name of person completing form:_________________________ Approved by SVH Infection Control Committee July 2008

17. Hand Hygiene Compliance Rate per 100 Observations 2011 2010

18. Goals: • Decrease hospital acquired C.Diff by 25% • by the end of 2011. Will set new goals for 2012. • Decrease overall hospital acquired infections • Increase hand hygiene rates to ??? 100% • Continue to engage front line staff regularly • Increase patient education regarding: • transmission, prevention, empowerment, etc. • Maintain and increase effective environmental cleaning • Bleach wipes in ICU and other areas when appropriate • Cleaning is everyone's responsibility, not just “housekeeping” • Maintain IP visibility on patient care units (this is NEVER ending!!) GO Patriots!

19. Team Effort All staff are responsible for patient safety Infection prevention is patient safety Safety trumps all!!! • Take away messages: • Wash, Wash, Wash (both hands and surfaces) • Include allclinical disciplines in the prevention of infection • Cleaning is everyone's responsibility, not just “housekeeping” • If something isn’t working, then step back and look at the big • and little picture again. Use rapid cycle PDSA (plan, do, study, act) • Reach out for help!! Either on a unit, supervisor, another discipline, • another facility.............include all appropriate disciplines

20. Questions???

21. Debra BerubeMS RNC CIC Director of Infection Prevention St. Vincent Hospital 123 Summer St, Worcester MA 01608 Office: 508-363-6240 debra.berube@stvincenthospital.com